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				<p style="font-size:14; font-weight:bold;">PERMIT TO LEAVE SCHOOL PREMISES ALONE</p>
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		<tr><td>I, </td><td style="width:245;" class="underline">&nbsp;</td><td>, </td><td style="width:245;" class="underline">&nbsp;</td><td> give permission to</td></tr>
		<tr><td>&nbsp;</td><td style="text-align:center; font-style:italic;">Name</td><td>&nbsp;</td><td style="text-align:center; font-style:italic;">Relation to child</td></tr>
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		<tr><td style="width:245;" class="underline">&nbsp;</td><td> to leave the school premises after dismissal without an adult companion</td></tr>
		<tr><td style="text-align:center; font-style:italic;">Name of Child</td></tr>
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			<td>and to take public transportation on his/her own. I am aware of the danger he/she may be exposed to and I do not hold the school responsible for anything that may happen after he/she has left the school premises.</td>
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			<td>Signed this day</td><td style="width:120;" class="underline">&nbsp;</td>
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			<td style="width:200;" class="underline">&nbsp;</td>
			<td style="width:200;">&nbsp;</td>
			<td style="width:280;" class="underline">&nbsp;</td>
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			<td style="text-align:center;">Witness</td>
			<td>&nbsp;</td>
			<td style="text-align:center;">Signature Over Printed Name of Parent/Guardian</td>
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			<td style="border-bottom:1 #000 dashed;">&nbsp;</td>
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